Primary care networks build on the core of current primary care services and enable greater provision of proactive, personalised, coordinated and more integrated health and social care. Clinicians describe this as a change from reactively providing appointments to proactively care for the people and communities they serve. Where emerging primary care networks are in place in parts of the country, there are clear benefits for patients and clinicians.
Primary care networks are based on GP registered lists, typically serving natural communities of around 30,000 to 50,000. They are small enough to provide the personal care valued by both patients and GPs, but large enough to have impact and economies of scale through better collaboration between practices and others in the local health and social care system.
7.13A.1.The Contractor must comply with the requirements in clause
7.13A.2 where it is:(a) signed up to the Network Contract Directed Enhanced Service Scheme (“the Scheme”); or(b) not signed up to the Scheme but its registered patientsor temporary residents, are provided with services under the Scheme (“the services”) by a contractor which is a member of a primary care network.
7.13A.2.The requirements referred to in clause 7.13A.1 are that the Contractor must:
(a) co-operate, in so far as is reasonable, with any person responsible for the provision of the services;
(b) comply in core hours with any reasonable request for information from such a person or from the Board relating to the provision of the services;
(c) have due regard to the guidance published by the Board;
(d) participate in primary care networkmeetings, in so far as is reasonable;
(e) take reasonable steps to provide information to its registered patients about the services, including information on how to access the servicesand any changes to them; and
(f) ensure that it has in place suitable arrangements to enable the sharing of data to support the delivery of the services, business administrationand analysis activities.
7.13A.3.For the purposes of this paragraph, “primary care network” means a network of contractors and other providers of services which has been approved by the Board, serving an identified geographical area with a minimum population of 30,000 people
2021/2022 PCN DES Changes
- ARRS increase in funding (£430m in 2020/21 to £746 in 2021/22).
- Expansion of ARRS roles (additional roles agreed in October 2020 to continue, and paramedics, AHPs and MHPs to commence from April 2021).
- IIF increase in funding (to £150m in 21/22, with at least £30m to incentivise access).
- Additional four service specifications will not be introduced from April 2021, given reprioritisation necessitated by the pandemic.
- More phased approach to the introduction of new IIF indicators for 21/22 (exact indicators and dates to be agreed).
- Access offer to be developed over summer 2021, and implemented from April 22.
- CP transfer from the Clinical Pharmacist in General Practice scheme allowed from 1 April to 30 Sept 21.
- London weighting for ARRS.
- PCNs will be entitled to an embedded mental health practitioner, employed and provided as a service by the PCN’s local provider of community mental health services, funded under a local agreement; 50% of the funding will be provided from the mental health provider and 50% by the PCN.
New service requirements in 2020/221
Requirements for the delivery of EHCHs by primary care networks (PCNs) are included in the 2020/21 Network Contact DES and associated guidance, with corresponding requirements for community health services and other NHS providers in the NHS Standard Contract. These requirements were fully implemented from 1 October 2020, including:
- every care home being aligned to a named PCN
- every care home having a named clinical lead
- a weekly ‘home round’ or ‘check in’ with residents prioritised for review based on MDT clinical judgement and care home advice (this is not intended to be a weekly review for all residents)
- within 7 days of re/admission to a care home, a resident will have a person-centred holistic health assessment of need (will include physical, psychological, functional, social and environmental needs of the person and can draw on existing assessments that have taken place outside of the home, as long as it reflects their goals)
- within 7 days of re/admission to a care home, a resident will have in place personalised care and support plan(s), based upon their holistic assessment
- the Network Contract DES also has a contractual requirement to prioritise care home residents who would benefit from a Structured Medication Review (SMR).
The Enhanced Health in Care Homes Framework has been updated to support the delivery of the minimum standards described in these contracts, and sets out practical guidance and best practice for CCGs, PCNs and other providers and stakeholders as they work collaboratively to develop a mature EHCH service, and should be read alongside these contractual requirements.
The NHS Long Term Plan commits to invest £4.5 billion of new funding to expand community multidisciplinary teams aligned with new primary care networks (PCNs) based on neighbouring GP practices that work together, typically covering between 30,000 and 50,000 people. Primary care professionals play a central role in helping to diagnose cancer early and supporting people as they live with and beyond cancer.
Early cancer diagnosis is one of three priority areas for PCNs from 2020/21 and the NHS Cancer programme has worked with a cross-sector working group to develop content for the Primary care network contract. The good practice guidance for the early cancer diagnosis service requirements includes advice for clinicians on safety-netting for PCNs and tools to implement robust safety netting protocols in EMIS and SystmOne.
Structured medication reviews and medicines optomisation
Structured Medicine Reviews (SMRs) are an evidence-based and comprehensive review of a patient’s medication, taking into consideration all aspects of their health. In a structured medication review clinicians and patients work as equal partners to understand the balance between the benefits and risks of and alternatives of taking medicines. The shared decision-making conversation being led by the patient’s individual needs, preferences and circumstances.
Problematic polypharmacy is where, for an individual taking multiple medicines, the potential for harm outweighs any benefits from the medicines and/or they do not fully understand the implications of the medication regime they are taking. This includes:
- medicines that are no longer clinically indicated or appropriate or optimised for that person
- combination of multiple medicines has the potential to, or is actually causing harm to the person
- practicalities of using the medicines become unmanageable or are causing harm or distress.
SMRs have benefits to people taking multiple medicines:
- improved experience and quality of care through being involved in the decision-making process and having a better understanding of the medicines they take
- less risk of harm from medicines (e.g. adverse drug events, side effects, hospitalisation or addiction)
- better value for local health systems (e.g. reduced medicine waste).
Across England, general practices are working together with community, mental health, social care, pharmacy, hospital and voluntary services in their local areas in primary care networks (PCNs). Professionals are working together to support patients with structured medication reviews as one of the PCN service requirements which commenced during 2020/21.
From October 2020, all PCNs are required to identify patients who would benefit from a SMR, specifically those:
- in care homes;
- with complex and problematic polypharmacy, specifically those on 10 or more medications;
- on medicines commonly associated with medication errors;
- with severe frailty, who are particularly isolated or housebound or who have had recent hospital admissions and/or falls;
- using potentially addictive pain management medication.
The number of patients to be offered a SMR will depend upon the PCN’s clinical pharmacist capacity. Further information on the expectations of PCNs and more detailed clinical guidance, for example from the Royal Pharmaceutical Society and NHS Scotland can be found in the Network Contract DES SMR guidance.
New service requirements in 2021/22
From 1st Oct PCNs must confirm or exclude hypertension where blood pressure exceeds thresholds in GP and community settings, including reviewing patient records of previous elevated blood pressure. From 1st Oct PCNs must improve coverage of checks including opportunistic testing and aligning with the Community Pharmacy hypertension service.
From 1st Oct PCNs must identify and include all learning disability patients and patients with SMI on the respective registers and make reasonable efforts to deliver the set percentage of health checks. By 31st Dec PCNs and Commissioners must jointly identify a population experiencing inequality in provision/outcome and begin engagement. By 28th Feb PCNs must have a finalised plan to tackle this unmet need and proceed to deliver this from 1st March.
New service requirements in 2022/23
In 2022/23 the CVD requirements expand to include atrial fibrillation, heart failure and familial hypercholesteremia, and requires quality improvement activity to support CVD prevention.
By 30th Sept 2022 PCNs must have an agreed a plan with their ICS and local partners based on forthcoming national guidance (to include cohort identification, data sharing, assessment of need, intervention decisions). By 1st Oct 2022 PCNs to have commenced operation with relevant partners.
Proactive Social Prescribing – work with stakeholders to proactively offer and improve access for an identified cohort with unmet need. Digitising Personalised Care – work with stakeholders to implement digitally enabled personalised care and support plans for care home residents. Shared Decision Making – ensuring clinical staff complete e-learning refresher training, and by March 2023 audit a sample of patient experience to inform improvements to Share Decision Making.
From April 2022 PCNs will deliver a single, combined extended access offer funded through the PCN DES. Further detail to be published this autumn.